Failure to Monitor Behavior for Resident on Psychotropic Medication
Penalty
Summary
The facility failed to conduct behavior monitoring for a resident who was prescribed the psychotropic medication escitalopram for major depressive disorder (MDD). The resident, who had moderate cognitive impairment and was dependent on staff for most activities of daily living, was admitted with a diagnosis of MDD and began receiving escitalopram as ordered by the physician for symptoms manifested by verbalizations of sadness. However, there were no physician orders or documentation in place to monitor the resident's behavior related to the use of this medication. Interviews with nursing staff and the Director of Nursing confirmed that behavior monitoring was required to track the frequency of the resident's symptoms and to assess the effectiveness of the psychotropic medication. Facility policy also required documentation of the rationale for use and monitoring for efficacy when medications were prescribed for behavioral symptoms. Despite these requirements, the resident did not have any active or discontinued orders for behavior monitoring since starting escitalopram, resulting in a lack of monitoring for the continued need or effectiveness of the medication.